Pancreas Path I Flashcards
pancreas
has head, body, tail
gland acini
tumors of pancreas
most arise from epithelium of large ducts
adenocarcinomas
pancreas divisum
improper fusion of duct
duct of santorini does not obliterate becomes main drain - to minor papilla to small bowel
and duct of wirsung becomes insignificant - may drain lower pancreas
embryo of pancreas
rotation of ventral anlagen
-rotates toward dorsal and fusion takes place
normally - has duct obliteration and wirsung duct left behind
duct of santorini obliterates and minor papilla nonfunctional
ERCP
can be used to see pancreas divisum
dye to ampulla of vater - no dye to pancreas
in minor sphincter - do see dye in pancreas
predisposition to chronic pancreatitis
pancreas divisum
annular pancreas
double bubble sign
part of pancreas drags behind and wraps duodenum
usually below sphincter of oddi
see green-tinged vomit**
double bubble
annular pancreas
bile tinged vomit
annular pancreas
acute pancreatitis
acinar cell injury or obstruction of ducts of pancreas
trypsin from acini - to small bowel - activated there so doesn’t destroy pancreas
enzymes digest pancreas in pancreatitis
mild acute pancreatitis
inflammation, edema, reversible
severe acute pancreatitis
life-threatening
-ARDS, shock, DIC
chronic pancreatitis
repeated bouts
causes of acute pancreatitis
alcohol
gallstones
also mutations in trypsin protein - shock - trauma - vasculitis - mumps
alcohol acute pancreatitis
better prognosis - but still bad
40yo male
biliary stones in acute pancreatitis
brown stones
female age 70yo
worse prognosis
pancreatitis path
autodigestion
saponification of parenchyma and adipose
injury can be to duct or to acini or both
duct obstruction in pancreatitis
initially edema
- secondary impaired blood flow
- ischemia
cells of duct begin to malfunction
spill enzymes to tissue - autodigests
PRSS1, SPINK1, CFRT
mutations in trypsin
acute pancreatitis
high risk of pancreatic cancer as well
diagnosis of acute pancreatitis
epigastric pain to back
fever, N/V
elevated serum amylase and lipase
acute pancreatitis early
enlarged with edema and red
some early white saponification
chronic pancreatitis
multiple bouts of acute
most common cause - alcohol abuse
also autoimmune - IgG4, and genetic mutations in trypsin
repeated bouts of epigastric pain to back followed by malabsorption
chronic pancreatitis
early chronic pancreatitis
days to weeks
intermediate chronic pancreatitis
months to years
late chronic pancreatitis
years to decades
hard - sclerotic tissue - calcifications
chronic pancreatitis
lots of pancreas is fibrotic
get calcifications that you can see on CT/Xray
chronic pancreatitis complications
calcification can cause severe pain - perineural fibrosis
stones
diabetes
ascites - constant destruction of peritoneal surfaces
pseudocysts
pleural effusions - ascites can traverse diaphragm
fat malabsorption**
true cyst
epthelial lining
- usually neoplasm - b9 or mal
- will continue to grow
- inside - depends on epithelium
pseudocyst
have no epithelium
- usually filled with something
- fluid not made by what is lining wall
- usually lined with granulation and chronic inflammaion
- usually do not grow in size
abscess
get walled off - creates area of fibrosis
- walls off acute inflammation
- pain and systemic infection
if remains in place - what is left is pseudocyst
-lining of cyst - no epithelium
pseudocysts in pancreas
inflammatory response to digestive enzymes in pancreas
pseudocyst forms
lined with inflammatory wall** - no epithelium
serous cystadenoma
elderly 60yo
make serous yellow fluid
makes cysts
benign
mucinous cystic neoplasm
mucin producing
create cysts
benign, borderline, malignant all common
pancreatic serous cystadenoma
smooth border - tumor full of lots of cyst
-yellow straw colored fluid - serous fluid
benign
slow growing painless mass in adult women in pancreas
mucinous cyst neoplasm
need to look at biopsy
pancreatic mucinous cystadenoma
smooth borders
-likely benign
mostly tall of pancreas
lining - epithelium making mucin - fills cyst
intraductal papillary mucinous neoplasm
duct epithilium produces neoplasms growing to obstruct lumen
-continue to grow and expand
mostly male - mostly benign - mostly head of pancreas
carcinoma of pancreas
4th leading cause of death in US
risk fx - old age, smokers, diet, hereditary
when discovered - widely metastatic
painless jaundice with pruritits
epigastric pai to back, jaundice, pruritis
possible pancreatic cancer
migratory thrombophlebitis
troussea sign
with pancreatic cancer
courvoisiers
palpable gallblader with pancreatic cancer
virchows node
left supraclavicular
with pancreatic cancer
sister mary joseph
umbilical skin mass
with pancreatic cancer
blumers shelf
rectal pouch mass
-drop mets - to this location
with pancreatic cancer
smoking risk fx for cancer in
pancreas lung HNSCC bladder esophagus
diagnosis of pancreatic cancer
CT scan common
endoscopic ultrasound
fine needle aspiration or needle core bx
Ca 19-9
elevated in pancreatic cancer
marker to follow treatment
not for diagnosis
aspiration
cell sucked out of tissue with negative pressure
exfoliative
scraped off surface
adenocarcinoma of pancreas
really hard - with irregular borders
KRAS
12p chromosome
altered in invasive pancreatic adenocarcinoma
desmoplasia
connective tissue deposition - makes tumors hard
